I'm not exactly adamant about "socialized medicine" : my wife and I are enrolled in one of the combination plans - Medicare plus Blue Cross/Blue Shield ; which, in our area goes under the name of "Horizon Medicare Blue" -(if I'm up-to-date on the name changes.)
As nearly as I can figure out the nuts and bolts of the program,a significant percentage of our coverage is funded by my wife's former employer, with Medicare picking up the slack. The whole cobbled-together thing is administered by Horizon Blue Cross/Blue Shield - the former employer's health insurance carrier. The way it works is a pretty fair analog for a "socialized medicine" plan.
Blue Cross/Blue Shield (to use the old name) is a "carrier of last choice" by law. It can't refuse to accept someone who has a pre-existing health condition , or any group of individuals apt to incur higher-than-normal healthcare costs. (That last description fits retirees and other senior citizens to a tee. Boy ,do we run up healthcare costs !)
The "private carriers" - Aetna, etc. - are permitted to exercise much more selection in their choice of whom to insure ,and, as a consequence , try to avoid retirees altogether, or charge much higher premiums to cover them. Most large employers look at the cost projections, shudder, and opt for "good old Blue" - at least for their rank and file workers.
I can't speak for other states, but in NJ, Horizon Blue Cross/Blue Shield is almost universally detested by healthcare providers - some of whom suggest dealing with them is like being nibbled to death by ducks. Payments are denied in what seems an arbitrary and capricious fashion -and the name of the game seems to be to delay payment as long as legally possible...while assuring all concerned "the check is in the mail".
For instance, when my wife was hospitalized in 2005, there was an unexplained balance left unpaid to the hospital. We explored this issue with the hospital and with Horizon for several months, and were told by the latter all invoices presented had been paid in full. In 2007, while my wife was in intensive care fighting for her life, I received a notice from a collection agency. The hospital had NOT been paid the balance, had given up trying to collect it from Horizon, and had finally invoked the little clause on the Admission documents that says the patient is responsible if the insurance carrier refuses to pay.
Knowing how my wife would react to this impossible situation (probable cardiac arrest) , I paid the bill : reasoning it would be a few bucks cheaper than paying for her funeral.
This month, we received two letters from Horizon: one claiming, although the treating physician had clearly authorized it, an X-ray was "not authorized" , and a small "co-payment" was due to the provider. The second letter was even more alarming !
This was, again, an X-ray, and Horizon had inexplicably decided my wife was " not a member of the group" at the time the service was performed.
WHOA ! Given the plan's reputation, it was easy to see what such a decision could lead to, so I called the phone number provided on the correspondence. It took just under an hour to reach someone at that number (and to learn the wrong number had been provided). Finally I was transferred to the Claims dept., where a pleasant gentleman assured me his records showed my wife had definitely been covered at the time of the claim....but he had no authority to make the neccessary change. He transferred me to someone in Enrollment , who he believed did have the authority.
The young woman in Enrollment confirmed coverage was in place and that it had never been interrupted...but, when she attempted to adjust the claim on the spot, she was denied permission to do so, as it had to go to somebody further up the Food Chain. We should get,she assured me, corrective correspondence in 10-14 working days. ( Dang ! Where have I heard that one before ?)
I think I've provided enough "personal examples" to give you the flavor of this huge,sprawling bureaucracy. Did I mention it provides warm welcomes to politicians who have been eased out of office by the electorate; that - for a very long time , its operations were being "outsourced" to India and other countries ?
I think of it as a foretaste of what a national socialized medicine program would become , and I would urge Americans to think : long and carefully before approving such a program !